Andrew David Stack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2289 Issued in CT

Practice address

1457 Whalley Ave
New Haven, CT 06515-1153

Phone

(203) 387-3937

Fax

(203) 389-3994

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University Alabama Birmingham - School of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Myeyedr Optometry of Connecticut LLCGroup PAC ID 1557666237, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myeyedr Optometry of Connecticut, LLC

  dba MyEyeDr.

  • Optometrist
  • Ansonia, CT
  • NPI 1396119194
  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Connecticut, LLC

  dba MyEyeDr.

  • Optometrist
  • Watertown, CT
  • NPI 1780058404
  NPD
• Myeyedr Optometry of Connecticut, LLC

  dba MyEyeDr.

  • Optometrist
  • Vernon, CT
  • NPI 1992207468
  NPD
• Myeyedr Optometry of Connecticut, LLC

  dba MyEyeDr.

  • Optometrist
  • Greenwich, CT
  • NPI 1639902711
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1306983648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1457 WHALLEY AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151153",
            "telephone_number": "203-387-3937",
            "fax_number": "203-389-3994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "ANDREW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "2289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Raphael Dialysis Center Partnership (Saint Raphael Dialysis Center)
• St. Raphael Dialysis Center Partnership (Milford Dialysis Center)
• Tayisha Rebecca St. Vil, WHNP-BC
• Amanda Lee Staak, PHARM D
• Jennifer Lyn Stabile, APRN
• Gary E Stack, MD
• Stages of Change Counseling
• Mary-Ann Alisha Staggers, LCSW
• Maximilian Stahl, M.D.
• Marissa Mae Staiger, MS

• Optometrist in New Haven, CT
• Providers in New Haven, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.